护士在辨别和应对暴力侵害妇女行为方面的作用

1 BACKGROUND

Violence against women (VAW) is the threat of or actual harm by physical, sexual or psychological abuse. Male violence, the most prevalent and dangerous form, is the leading contributor towards death, disease and disability amongst women aged 18–44 globally (Ellsberg et al., 2008). This type of abuse is extremely common; a recent survey of over 22,000 UK women found that as many as 99.7% report hing been repeatedly subjected to rape, harassment and physical violence over the course of their lifetime (Taylor & Shrive, 2021), far higher than previously thought. The Femicide Census, which tracks the murders of women by male perpetrators, also consistently reports over 100 deaths per year; rougly one woman every 3 days (Ingala Smith, 2018). Violence against women is a clear and serious public health concern with significant implications for the health, well-being and mortality of women around the world. However, violence should not be an inescapable aspect of women's lives; it can be prevented.

Victims, also commonly referred to as survivors, are likely to require care and treatment from healthcare services (Hooker et al., 2020). Despite this, the nursing response to this issue has been inadequate to date. Nurses and other healthcare professionals can play a vital role in recognising and responding to violence against women and its common expressions; domestic abuse and sexual violence (Bradbury-Jones, 2015).

How this issue is framed is central to how it is perceived or understood and reflects wider social issues in the UK and around the world. Violence against women is a common term and used throughout this discussion to highlight the health and well-being needs of women. However, this tends to obscure the source of the violence: men. When considering these issues, it is therefore important to remember that they do not occur in a vacuum and instead take place against a backdrop of misogyny, male dominance and women's subsequent inequality. Moreover, the ongoing failure to adequately address this issue within nursing and health care is intrinsically linked to medical paternalism and the dominance of medicine over the healthcare hierarchy.

2 WOMEN’S PROBLEMS

In the not-too-distant past, efforts to address violence against women within health care he been described by medical colleagues as ‘ill-considered professional interference’ and that it is ‘doubtful’ women would benefit from support (Fitzpatrick, 2001). This reluctance echoes broader social attitudes that he historically regarded domestic abuse as a private matter and has contributed to the hidden nature of abuse, stigma and ongoing normalisation of male violence.

Within the constructs of a patriarchal society, where male violence is intrinsically linked to male dominance, women remain subjugated, and their experiences hidden. Typically, women's problems are regarded as being a personal problem for women to fix. This obscures the perpetrator of violence and places the blame and responsibility upon victims to keep themselves safe, rather than addressing the source of the problem.

However, whilst perpetrators are solely responsible for violence and abuse, literature on perpetrator recidivism is severely lacking. A community approach to this issue has been shown to be the most effective prevention and intervention strategy (Hague and Bridge, 2008) and forms the rationale for the ongoing implementation of multi-agency risk assessment conferences (MARAC) across local authorities. Nurses, as the largest healthcare professional group, must therefore form an active component of this response, identifying and responding to risk, co-ordinating care and safeguarding women.

3 DEVELOPING KNOWLEDGE

Women who he experienced male violence repeatedly express the importance of supportive, empathic staff and psychologically safe environments (Bradbury-Jones, 2015). In order to achieve this, staff must be knowledgeable and competent in recognising and responding to signs of abuse and disclosures.

Whilst individual nurses may choose to develop their knowledge and understanding in this area, a small number of nurses scattered across services, boards and trusts are not able to lead care on a large scale nor are they able effect the kind of change necessary. A systemic approach is therefore needed that prioritises learning and development and ensures sustainability.

Investing in training and staff development is vital to ensuring staff knowledge and competence. However, training deficits are consistently noted in research. Nurses frequently report lacking the knowledge, confidence, and training to recognise and respond effectively to domestic abuse and sexual violence (Alshammari et al., 2018). As a result, nurses oid asking about abuse since they are unsure how to ask sensitively and how to respond to a disclosure.

The ongoing lack of development in this area is, no doubt, due to the lack of importance placed upon women's lives, health and well-being. Training is not prioritised in undergraduate curricula or CPD, and specialist nursing staff, capable of delivering such training, are vanishingly rare. But this is nothing new, health care, an historically paternalistic institution, has presided over women's health inequalities for hundreds of years.

4 PATERNALISM AND GENDER ROLES

Within healthcare systems, patriarchy and male dominance find expression in medical paternalism. The traditional dominance of medicine, which once excluded women entirely, remains present to some extent within modern health care. Medical staff, afforded the highest degree of autonomy within healthcare systems, continue to lead in research, policy development and service design and delivery the majority of the time. As such, doctors, nurses and patients exist within an operational hierarchy with medicine dominating from above. This dynamic is inherently gendered, with medical staff acting in the masculine role as dominant protectors and patients as passive, feminine and dependent recipients. Within this system abused women are doubly subordinate, to both their abusive partners and to healthcare staff, and very often must relinquish their autonomy in order to receive the care and treatment of health professionals.

Despite a focus on patient centred care, nursing can often be guilty of participation within these structurally oppressive and misogynistic practices where the patient remains subordinate. The nurse's role is typically one of concern and advocacy; however, even this should be acknowledged as taking place from a position of superiority, control and dominance.

A cursory glance of online patient feedback site Care Opinion reveals many poor experiences for women who disclose abuse to healthcare staff, including nurses of both sexes. This feedback often reflects a lack of staff knowledge and sensitivity, whilst patients nigate retraumatising practices and procedures. Despite being a majority female workforce and being more likely to he experienced male violence than their non-nursing peers (Cell Nursing Trust, 2016), experience alone is not sufficient to guide high standards of nursing care or eradicate the possibility of internalised misogyny within the profession.

However, nurses, as the largest patient facing workforce and who frequently lead on the development of models of care, should be well placed to not only identify and respond to violence against women; they are also well placed to lead strategic development in this area. This is not without its challenges since nurses, too, are subordinate to the dominant medical hierarchy. This unique position of being both the dominator and the dominated presents a tension that is not possible to resolve entirely without addressing the structural oppression of women within health care, at every level.

Healthcare leaders, managers and educators must therefore prioritise education, development and training on the issue of violence against women in order to improve knowledge, standards of care and ultimately women's health and well-being outcomes. However, they must also recognise and challenge the structural barriers, misogyny and oppression that has prevented or restricted development for women as patients and practitioners thus far. The influence of nurse leadership has profound implications for patient outcomes (Francis, 2013), and this is particularly true for the role of health care in addressing violence against women. Whilst the gendered nature of this issue is recognised, nursing leaders, organisations, unions and institutions he a role in challenging the status quo with clear implications for patient care.

5 CONCLUSION

Male violence is a significant public health concern affecting a high percentage of women. Nurses and other healthcare professionals he a responsibility to recognise and respond to the signs of domestic abuse and sexual violence in order to address ongoing health inequalities, safeguard women and ultimately se lives.

Ending violence against women cannot be achieved by individual nurses, however, and ultimately requires systemic change and investment in training, development and research. If nurses are to address the significant risks facing women, then nurse educators, leaders and managers must prioritise and invest in the development of knowledge and care to ensure that registrants are confident and competent to address this issue.

Importantly, they must also recognise and challenge the oppressive and structurally patriarchal systems that present barriers to advancing practice and understanding in this area. Ultimately, it is women who will continue to suffer the burden of inaction.

ACKNOWLEDGMENT

Both authors contributed equally to this editorial.

CONFLICT OF INTEREST

The authors declare that they he no Conflict of interest.

节录转译（仅供参考）

对娼妓的恐怖 (VAW) 是胸部、开放性或心理强暴的威胁或实际伤害。年长恐怖是最普遍存在和最危险的形式，是随之而来全球 18-44 岁男同开放性恋死亡、结核病和残疾人的主要原因（Ellsberg 等，2008）。这种一般来说的不道德极其普遍存在；最近对至少 22,000 名英国男同开放性恋进行的一项调查发现，多达 99.7% 的男同开放性恋调查报告并称，她们一生中的多次造成、扰和胸部恐怖（Taylor & Shrive，2021 年），远高于之前的预期。年长向警方定罪娼妓的杀戮男同开放性恋人口普查也过后调查报告每年至少 100 人死亡；大约每 3 天就有一个女人（Ingala Smith，2018）。恐怖不作为娼妓行为是一个具体而严重的公共卫生难题，对多国娼妓的身心健康、有益于和死亡率激发不小影响。然而，恐怖不应成为娼妓穷困中的不可避免的一个多方面；这是可以预防的。

犯人，一般而言也并称为凯恩，很不太可能不能医疗保健增值政府机构的保健和化疗（Hooker 等人，2020 年）。尽管如此，在世界上，助产士对这个难题的反应还不够充分。药剂师和其他医疗保健机械工程人员可以在定位和防范恐怖不作为娼妓行为及其少见理解多方面展现出不可忽视依赖于性；贫穷强暴和开放性强暴（Bradbury-Jones，2015 年）。

这个难题的基本概念是如何看待或忽略它的核心，它反映了英国和多国更加最常的社会难题。对娼妓的恐怖是一个少见术语，在整个提问中的使用以重申娼妓的身心健康和有益于供给。然而，这经常忽视了恐怖的来源：年长。因此，在考虑到这些难题时，不可忽视的是要记住，它们不是在真空中的发生的，而是在厌女症、年长主导者和男同开放性恋随后不应有的背景下发生的。此外，在保健和医疗保健层面多年来未能充分防范这个难题，这与医疗保健家长作风和医疗保健在医疗保健品位中的的主导者声望有着内在的建立联系。

在刚刚的只不过，防范医疗保健中的针对男同开放性恋的恐怖行为的尽力被临床上司描述为“考虑到不周的机械工程干涉”，并且“怀疑”男同开放性恋前提会从全力支持中的受益（Fitzpatrick，2001 年）。这种不情愿与更加最常的社会态度互为呼应，这些态度历来将贫穷强暴视为不对，并随之而来强暴、破坏者和年长恐怖过后中日关系的隐藏开放性质。

在性解放社会的结构中的，年长恐怖与年长统治有着内在的建立联系，男同开放性恋几乎被征服，她们的亲身经历被隐藏好像。一般而言，男同开放性恋的难题被确信是男同开放性恋不能防范的个人难题。这忽视了恐怖的向警方，并将法律责任和法律责任推给了犯人以必要自己的安全，而不是防范难题的开端。

然而，虽然向警方防范恐怖和强暴负全部法律责任，但严重考虑到到关于向警方的史籍。防范这个难题的社区步骤已被证明是最有效的预防和干涉策略（莱顿和布里奇，2008 年），并构成了跨偏远地区当局过后推行多政府机构风险评估会议 (MARAC) 的简而言之。因此，药剂师作为第二大的医疗保健机械工程群体，不能成为这一防范新外交政策的鼓励当今世界，定位和防范风险、互互为配合保健和确实措施男同开放性恋。

亲身经历过年长恐怖的男同开放性恋反复理解了全力支持、善解人意的管理人员和心理安全环境的不可忽视开放性（Bradbury-Jones，2015）。为借助这一最大限度，管理人员不能科学睿智且有控制能力定位和防范不道德和披露的迹象。

虽然个别药剂师不太可能会必需蓬勃发展他们在该层面的科学和忽略，但分散在增值、管理委员会和信托中的的少数药剂师只能大规模领袖保健，也只能进行确实的改革。因此，不能一种不足之处步骤，前提考虑到研习和蓬勃发展并必要可过后开放性。

注资于招聘和管理人员蓬勃发展对于必要管理人员的科学和控制能力至关不可忽视。然而，在研究中的多年来注意到招聘原因。药剂师经常调查报告考虑到到认识和有不稳定开放性对贫穷强暴和开放性强暴的科学、自信和招聘（Alshammari 等人，2018 年）。因此，药剂师避免询问强暴，因为他们不已确定如何敏感地询问以及如何表示披露。

毫无疑问，该层面过后考虑到到蓬勃发展的原因是考虑到到对娼妓穷困、身心健康和有益于的十分重视。人文科学或 CPD 不曾前提考虑到招聘，并且并能备有此类招聘的机械工程助产士极其罕见。但这并不是什么新鲜事，医疗保健是一个历史上家长式的政府机构，数百年来多年来在主导者着男同开放性恋的身心健康不应有。

在医疗保健系统中的，父权制和年长主导者权在医疗保健家长作风中的取得体现。曾经实际上排斥男同开放性恋的传统临床主导者声望在许多现代医疗保健中的几乎存在。的医院在医疗保健系统中的享有三高程度的自主权，他们在大多数实际上一直领袖研究、外交政策制定以及增值其设计和交货。因此，医生、药剂师和病变存在于一个操作步骤层次结构中的，临床自上而下%主导者声望。这种自适应只不过上是开放性别化的，的医院作为主要确实措施者充当年长角色，而病变则是互为反、男同开放性恋和依赖于的接受者。在这个系统中的，受强暴的娼妓对施虐的家庭成员和护士都具有双重实质上声望，

尽管专注于以病变为中的心的保健，但助产士经常会因参与这些不足之处屈从和厌恶男同开放性恋的做法而令人内疚，而病变几乎处于实质上声望。药剂师的角色一般而言是关注和宣扬的角一；然而，即便如此，也确实承认这是在优越、控制和从属声望上发生的。

单单上传一下在线病变反馈网站 Care Opinion，就会发现向护士（包括**药剂师）披露强暴行为的男同开放性恋有许多拙劣的亲身经历。这种反馈一般而言反映了管理人员考虑到到科学和敏感开放性，而病变则在防范于是又伤痛实践和机制。尽管男同开放性恋劳动力%多数，并且比非保健早熟更加也许造成年长恐怖（Cell Nursing Trust，2016 年），但仅凭经验不足以他的学生高质量的保健或消除内化厌女症的不太可能开放性。职业。

然而，药剂师作为第二大的病变面对的劳动力并且经常领袖保健模式的蓬勃发展，不仅确实并能定位和防范针对娼妓的恐怖行为；他们也有控制能力领袖该层面的战略蓬勃发展。这并非未同样，因为药剂师也实质上于%主导者声望的医疗保健品位。这种既是自然法则又是被自然法则的鲜明声望显出一种紧张局势，如果不防范各级医疗保健中的对娼妓的不足之处屈从，就不不太可能实际上防范这种紧张局势。

因此，医疗保健领袖者、管理者和名学者不能前提考虑到关于恐怖不作为娼妓难题的教育、蓬勃发展和招聘，以提高科学、保健规范并于是又一提高娼妓的身心健康和有益于。然而，他们还不能认清并同样在世界上阻碍或允许男同开放性恋作为病变和从业者蓬勃发展的不足之处障碍、厌女症和屈从。药剂师领袖力的影响对病变的预后有着深远的影响（Francis，2013)，尤其是医疗保健在防范恐怖不作为娼妓行为多方面的依赖于性。虽然该难题的开放性别开放性质已取得认可，但保健领袖者、组织、的工会和政府机构在同样从根本上多方面展现出着依赖于性，对病变保健有具体的影响。

年长恐怖是一个不可忽视的公共卫生难题，影响到很高数量的男同开放性恋。药剂师和其他医疗保健机械工程人员有法律责任定位和防范贫穷强暴和开放性强暴的迹象，以防范过后的身心健康不应有难题，确实措施娼妓并于是又一扭转生命。

然而，终止对娼妓的恐怖行为只能由个别药剂师借助，于是又一不能不足之处改革以及对招聘、蓬勃发展和研究的注资。如果药剂师要防范男同开放性恋面临的不小风险，那么药剂师学时、领袖者和管理人员不能前提考虑到并注资于科学和保健的蓬勃发展，以必要注册者有自信并有控制能力防范这个难题。

不可忽视的是，他们还不能承认并同样屈从开放性和结构上的父权制度化，这些制度化对推进该层面的实践和忽略构成了障碍。于是又一，男同开放性恋将一直太重不作为的负担。